GW1--03719_Well Construction - GW1_20230602

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WELL CONSTRUCTION RECORD(GW-I' - For Internal Use Only:
1.Well Contractor Information.
+cam t6. co I4.WATER ZONES
.�� 'FROM TO 1 i DES WrjON
Well ContracturNamc
!ocii f. 1 R.
NC.Well Contractor CetfificatianNumber ¢• ` 01l11J3 CASENTO ntormnItkased wens)Ott LINER tir + 4: )
` '�~ :.P`;.�y. 'Jr - a $ _a� PROM I TO I MAMMA I TmCgr s MAT RIAL ft. ft. tO
Company Name
.�if�ll CilIl6I1'IILfTQIIPQI'llal�$I a a- I - PROM RCA IxfiOg IMG(geothermalelos taaoy
TO .J nLAlt] 1111CR MATERIAL
Ltyt all applicable well construction permits.(i.e.FIIC.Counry.ylate.Variance,ere.) 0 It -4 y`' it. (0. 2�-in• 5 u2-- 4 evc,
r.Well Use(clinic well use): ft. It. in
Water Supply Well: i7. C EII+i•
Agtictr]tural FBO�£ TO , DIAMETER SLOTSIZt< I Tr3ICt�NERS MATERIAL
-.."cipalreublic ft
ft. , in.
Eieothcrrnnl[lioatinglt anling Supply) 1&s side atial WararSupply((ash-ogled)) {
RIndustrial/Commercial Q1Residential;am
Supplg(showed) 3g ftEtOUT I �-
litigation
I TO
MATER1M, E�trtLLACE STMETRon&,AMOUNT' 1
In.WaterSapg Well: 0 €(. ft.
Monitoring P �c t t�`� II r'�4 0
ection Welk ft. OM?
quifer
Recharge �GrouadwaterRcmcdiation ft '
quiferStorage end Recovery �gall�fy Barrier 9AI+1iNt S1►IiEI;PACKfJft ultcattle}
i•$OSf TO Bf111ESL4L FRfPt4CEtSE.VrMaTIIon
qulfcrTCst �#5tflrmwaterllrainage ft. ft.
eperimental Technology °Subsidence Control It. ft.
enthcrmal(clasctl Loop} Ttacct D(( av su (stmthnaattiar> r«taJ ? .
TO
eothermal(ideating/Cooling Retur) Other(explain under#21 Remark) •` FROM ft ff•
nlSe t:TTole(mimIllani 2,seJrharkr�e.etarasiie. 1
4.11ate Weil(s)i tlmpieted:S=!�-- Well rqf ®� 'it aw -\-C c u ..
SO.Wall Location; ft. ft
� �:, a t [ }Z [ i',t_. ft. ft. ; :.s ' ..- . 'a,_.' '1 I
u'c P 6,...€ .�J.:- _ ,r
PncilitylOwueaName1— r� FacHitylDg[ireppecaltlel i rt. ' it. {{`` � r n ------
Lp'� Z'cir_ 11--ri Val grciart c 5, �12 h. JUN G , 4.02J
PLysicat Address,CitytandZiip -
it: r
�Y'C.M•ilVC.,_T CA, ci564.(02nl UZtt,_00a 21.REh3ARl( �v;� :: .j
County Parcel Identification No.(PIN)
5b.Latitude anti longitude in degrees/anlnntestseconds or decimal degrees:
of well field.one lndlongls seinerent) 22o Certification:
6Js(ase)floweilts) rmanent or EpTemporarg-
ptmtuteo€CcRftiedlveUContracttu Date
I.Is this a reptile to an existing well: Eli;
By slgnitlg Miriam f hereby cagy that the Kell(s)was(were)Conrtyvcied in arearffimca
g Ores or lr:l with I5ANCACO2C.Ola&ar 15ANCMC O2C,O200 Well CansurctJaa Standards and that a
if MI.tra repair.f III our iwotn;vellcoturructiaainferrtatimrartdexplan' the nature of the (*DX aid*reserd hat berniirauidedto the welt owner-
repair under4Z1 remarkrseeiiatr aronthe bar kof thfsfarm.
2 .Sfte(Bea anoradditioaetwcndetails)
S_IrOr t eopnoheJDP1 or Closed-Loop€.'eatlieraia}Webs having Liter MUSIC
may use the back of this page To provido additional won site dacclis or well
co winiotton+only OW-I is All�dud. T4F 1 €ii of woks rnastmetioa damns-You may alsoauachadditioaal pogoc t�faeeeseely.
drilled:
/ SURM I3M6.r 1NsTRUCsaalvs
9.Total well depth below land surface: 3�3 )
Per maltfptemeltslinoildepdzc+lrlill +u(Emmplo-3a�2OO'and2@;OQ) (t. 20.For1 1 Welk: Submit this ip�within 30 days of completion of well
consuuctiontorhe fallowing:
10.Static water level below top of casing: tip (ft.) Division ofW►ater Resources,Information Processing
lftsz+terlecelisabove msfrlg,tae"T" 161714all Service Center,Raleinh,NC 2%994617
11.Barebaiediameter (.0- 2-g-- ON
0o 24h. 'or 1tlle_et)on Wells: In addition to sending the form to the address in 2da
i?.Well construction method; �,t^?'1 O1 t?.�� above,also submit one copy of this form within 30 days of completion of well
(te.auge,mtay,rebimracctpnsb.ttc� ® CiIIISiIiIC60II tote ftlll©SVlllg;
FOR W .TP:R SUPPLY WELLS ONLY: Envision og Water chnnor„es,Underground Injection Control Program,
#fell Service Center,Ralelgh,NC 2709 I636
oftesta
13a,Yield(gpm)_7 Method q Ci I. l n -&1 i}-OI 24c.For Writer Stmnly&Injection Wells: fa addition to sending the farm to
13Et.Disitl€ection type: Ch l Dr° - AJasonab �-
.1.... e th ntldress(es) above,also Submit One Copy of this form within 3D dabs of